Working Together: Utilizing Information Systems in School Law Amanda Timmons Janis Betten Oregon DHS, Public Health, Immunization Program Oregon’s immunization law requires that immunization data be collected by schools and children’s facilities. Schools and facilities report this data to local health departments who in turn report the information to the state. This system has been in place since 1982. Much of the required tracking, until recently, was done by hand. In this age of sophisticated information systems, something had to change.

Immunization Data Systems Oregon Immunization ALERT IRIS School Exclusion Module School and Childcare Student Information Systems This presentation will cover three systems used routinely in the annual review and exclusion process: Oregon Immunization ALERT is Oregon’s statewide immunization registry. It allows schools, facilities and local health departments to easily access immunization records for children in their care. The IRIS school exclusion module is a tool used by local health departments to track site data on schools and facilities, issue exclusion orders and create reports necessary for the review cycle. School and childcare information systems are used by schools and some facilities to assess immunization records of their children and to create the report they turn in to the local health department.

Problem Children in schools and child care often have incomplete immunization records. Getting parents to update records can be difficult. School and child care staff cannot access record directly from medical providers. The Oregon Certificate of Immunization Status must be on file for all attending children Parents often unresponsive to mailed reminders Oregon law does not specifically allow sharing of immunization records between medical practices and schools and child care.

Oregon Immunization ALERT Solution Oregon Immunization ALERT Oregon’s Statewide Immunization Registry

This is the opening screen for ALERT’s web based history search This is the opening screen for ALERT’s web based history search. This is the screen users see after they have logged on with their email address and secure password.

Uses of ALERT Complete record can be used in place of a Certificate of Immunization Status (CIS) Incomplete record can be used to supplement a CIS Record is considered verified and does not require a parent signature Authorized users can access ALERT online 24/7 Phone/fax access is available Monday through Friday, 8:00 AM to 5:00 PM Sites that have multiple histories to look for can send a list of names and phone numbers to ALERT electronically. ALERT will then send records back to the site.

Web access includes forecast for children through age 8 years Test 9/13/2000 Web access includes forecast for children through age 8 years The immunization forecast follows the recommended ACIP schedule A Link is available to the immunization school law webpage for those who have questions about school law requirements.

Methods Integrate registry with all facets of Immunization Program. Include schools and child care as valuable consumers of registry functions. Work closely with registry staff to enhance capabilities of importance to schools. Registry staff are integral to all aspects of Immunization program Schools have always been considered primary users and their use of system seen as directly benefiting clinics School law and registry staff work together to determine enhancements and to support each other through the exclusion cycle.

Upcoming Enhancements Ability to print completed CIS form from ALERT history Separate forecast for schools & child care This is a draft of Oregon’s new CIS One button printing of immunization history in CIS format from ALERT web page Link to a separate forecast using school/child care algorithm, which is different than ACIP.

Oregon’s Immunization Exclusion Cycle County Health Departments Exclusion orders mailed by 1st Wed. in Feb. Parents Parents must update records before 3rd Wed. in Feb. Follow-up data Copies of orders My colleagues thought that the next information would be more useful if you understood how immunization reporting happens in Oregon. They also felt that a diagram was the best way to present the information. This slide is my best effort.  Let’s see if I can clarify: All schools and children’s facilities prepare an initial immunization report on their total enrollment. It is due to their local health department in early January. For children who are missing immunizations or who have no record, the name of the child’s parent and mailing address, along with a copy of the CIS if available, are mailed with the initial report. No later than the 1st Wednesday in February, local health departments send exclusion orders directly to the parents of children needing immunizations. Copies of the issued exclusion orders are also sent to the school or facility. Parents update their child’s immunization record directly with the school. If the record has not been updated by the 3rd Wednesday in February, the child is excluded from attendance by the school or facility. Follow up information on all children receiving exclusion orders and statistical data on children in daycare and preschool, kindergarten, 1st grade and 7th grade are sent back to the local health department no later than 12 days after the exclusion date. Schools, Preschools, Child Care Centers Initial report due to CHD in Jan. Children whose records are not updated are excluded by school

Problem Annual exclusion cycle managed on paper. 35,000+ exclusion orders issued by hand in a two week period. No way for state and counties to share information. This is a very labor intensive process in the best of years. In one cycle (SY03-04), 50,028 orders were issued and 9,208 children excluded.

IRIS School Exclusion Module Solution IRIS School Exclusion Module Oregon’s Immunization Record Information System

Uses of School Exclusion Module Manage demographic data on sites subject to immunization reporting. Manage data to create required county-level and state-level reports. Speeds up issuance of exclusion orders and reduces need for paper copies. Allows tracking of trends down to site level. The information stored in the IRIS School Exclusion module is useful in a number of ways: Records only need to be updated in one place. County and state staff have access to records Used data for religious exemption analysis down to a site level.

Site Main Screen This is the site main screen where site demographics and primary report numbers are tracked.

Issuing Exclusion Orders Two types of exclusion orders are used, one for incomplete/insufficient records and one for no record on file. Orders can be printed individually or batch printed. We use special paper that already includes the state seal and form number on the front and the hearing rights on the back.

County-level Data Report County level data used for analyzing trends.

State-level Data Reports State level reports used to complete the CDC required reports.

Methods JADs – Joint Application Design. Continual assessment of proposed functionality. Work closely with end users to assure that system meets their needs. JAD sessions with county immunization coordinators, data entry staff, state program staff and computer programmers jointly determined system requirements. Users continually suggest new reports and functionality. During the cycle, frequent contact with end users assures that system is working.

Upcoming Enhancements Ability to select more than one reason for a record being insufficient. Report that generates how many exclusions issued by antigen type. Allow export of generated exclusion orders into a .pdf file. Orders by antigen type would be used to determine vaccine ordering needs, as well as staffing and supplies for special clinics. Export of generated orders would allow for printing on any printer, as well as faster batch printing.

Problem Schools with large numbers of children cannot assess all immunization records manually. Assessment must adhere to Oregon-specific guidelines. Requirements for reporting in Oregon are detailed and exact. Some schools have enrollments of of over 2500 students. Oregon tries to use ACIP guidelines where possible, including required number of doses and spacing between doses. All systems must assess records correctly. Oregon requires that systems: 1) use our specific category labels; 2) print reports in a specific order; and, 3) are easy for a non-user to read and understand. In addition, systems generally must allow invalid information to be entered (dates out of sequence, dates before birth). Records then receive an overall assessment of insufficient.

Oregon-Approved Student Information Systems Solution Shot Minder is only one of many approved systems. Thanks to the programmer, Jack Buster, who shared a copy of his program, I am able to show you screen prints of this system as an example. Oregon-Approved Student Information Systems

Currently Approved Systems Integrated Student Systems Advanced Programming and Design (K-12) Beaverton SD (PreK-12) Bend-Redmond (K-12) Central Point SD (K-12) Clackamas ESD (K-12) Coos Bay SD (K-12) Eugene SD (K-12) Oregon Edvantage (K-12) Medford SD (K-12) Multnomah ESD/Portland SD (PreK-12) NCS/Pearson (K-12) Pentamation (K-12) Salem SD SASIxp (K-12) Schoolmaster (K-12) N Marion SD SASIxp (K-12) Three Rivers SD (K-12) Stand-alone Systems EC Cares (PreK) ShotMinder (PreK-12) Nurses Aide (K-12) Some systems are local (Shotminder, EC cares), others are national (Pentamation, Nurses Aide), some are used in more than one country (AAL) All of these systems have an immunization component that can assess immunization records, assign an overall assessment label and print data reports needed to comply with CDC reporting requirements.

Methods Oregon Administrative Rules require prior approval of computer systems before they can be used to assess or report. Each system receives a requirements packet and school law handbook detailing system requirements. Use of a standard test deck is used to evaluate the system

Methods - continued Provisional approval granted for the first review cycle. Any programming issues identified during the cycle must be corrected promptly. Administrative rule allows revoking approval if identified issues are not resolved.

Tracks Site Data

Tracks Immunization Data

Tracks Exemption Data

Primary Review Summary Form

Lessons Learned Information systems can improve and streamline current processes. Identify key users from the outset and consider their needs during system design. When feasible, engage end users in the design phase, and keep options open for future enhancements.